I was browsing through the Air Force’s website for graduate medical education today when I came across a letter from Colonel Hall, the director of physician education. She states that the selection rate for medical students is as high as 75%. What that means is that 1/4 of fourth-year medical students applying to residency will not match. That’s a pretty disheartening statistic to read, especially given that more than 94% of applicants match through the civilian route. I remember being a na‹ve pre-med who bought into the lies told by recruiters that 98% of medical students enter the specialty of their dreams. If I had known then that I’m about to spend several years as a general practitioner, I never would have accepted the scholarship.

Even more disheartening is that this chief does not seem to know how competitive certain Air Force specialties are compared to their civilian counterparts. She writes, “The more competitive or popular specialties such as Anesthesiology, Radiology, Emergency Medicine, and the Surgical sub-specialties have a higher non-selection rate than some of the Primary Care specialties- paralleling the outcomes in the civilian match through the National Residency Match Program (NRMP).” Anesthesiology and emergency medicine are competitive in the civilian world? According to the data published by the AAMC, anesthesiology and EM are only moderately competitive at best. With greater than 90% match rates in both specialties, the average medical student certainly has a shot at getting into these fields.

Christ, why did I ever sign up for this?

Update: you can’t watch television or a movie these days without seeing some high school student boasting to his parents that he can get a free college ride by enlisting in the military. Historically, the Montgomery G.I. Bill has provided educational benefits to veterans in return for their service. Currently, the G.I. requires a buy-in of $100 per month for the first year of service only to provide a little over $1000 monthly in educational benefits after leaving the military. Other than community colleges and a small number of state universities, few places offer annual tuition costs at less than $14,000. Even then, the money does not cover all of the necessary living expenses, books, and equipment that is incurred as the reality of obtaining a college degree. Recently, Senator James Webb of Virginia has introduced legislation which would guarantee four years of tuition at most expensive public schools in addition to living expenses. His reasoning is that the current G.I. bill needs to be overhauled to perform its stated mission. His bill cleared through the Senate with a 75 to 22 bipartisan vote. But guess who is opposed to this legislation: Bush II and Bush III. And I thought medical students had it bad.

halfmdsaid,

Matching in the military involves a two-step process. First, you apply for a specialty. For example, you might apply for general surgery as your first choice specialty. The military also allows an optional second choice. Therefore, you might apply to orthopedic surgery as your second choice. You are not required to list a second choice. Second, you will then apply for training locations. Similar to a civilian match, you will list—in order of preference—where you want to train, including listing “deferral” in hopes of being granted a civilian deferral. For example, you might list 1. Wright-Patterson, 2. Wilford Hall, 3. deferral, and on down the line.

When I say that the Air Force has a 75% selection rate, I’m referring to part one. In other words, a quarter of medical students will not match in the specialty of their choice—both first and second choice. If you are not selected for a specialty, you do not get a civilian deferral. Instead, you are sent to work as a flight surgeon or GMO.

Ch3MDsaid,

Sounds as though the desires of the medical students do not match up to the needs of the military.

In the civilian world, the number of slots in each specility is relatively stable.

I don’t know how the military determines the number of slots in each speciality for each year, but I’m guessing that it is more dynamic than the the civilian world, and in theory is based upon the projected needs in each specility.

halfmdsaid,

You are correct. The Air Force does use projected need as a basis for how many spots are available each year. I really wish that the military would be more transparent about the difficulties of matching. Not only is the selection rate unacceptably low, but not all specialties are available. For instance, medical students are not allowed to apply to dermatology or aerospace medicine. And no one in the Air Force is allowed to apply to physical medicine and rehabilitation, genetics, or any combined specialty with the exception of family medicine/psychiatry. I think fewer people would apply for the HPSP scholarship if they knew the truth.

CHenrysaid,

Ch3MD: you are correct. The projected need drives the availability of training slots, all other things being equal (for instance satisfying specialty certifying organizations requirements for surgical case volume, ACGME requirements, etc.)
The desires of military medical students vis a vis specialty choice pretty much represent medical students generally. I don’t think there is a surgical bias or other bias.

halfMD: the reason the military doesn’t track step 2 is that it becomes the frayed end of the selection process after a couple of years. Some who are rejected at first application do not apply again, they make up their minds to leave and go civilian. Some have three year payback obligations, others four years. Some accept offers on successful reapplication, many don’t, some are never successful and choose to leave for civilian training rather than stay in the service or apply for something else. In the end, no one appears to be tracking a class cohort starting at medical school graduation to see exactly what happens to those who aren’t selected for full training at the outset, probably because that information is not much a driver of anything as long as the numbers of GMO slots are filled. As long as they program the numbers of specialty trainees they think they will need and the mission-essential GMO slots are filled, they pretty much don’t care what happens to the medical students they get from HPSP. Harsh but true.

Whoa, the MGIB is most certainly enough to pay for college, you just have to go to an inexpensive state school. Tuition at my Alma Mater for in-state runs about $8,000 per academic year. I don’t know why the the taxpayers should fund a free ride to Harvard or Yale. Like most things, the generics are just as good and the “premium” for the name brand isn’t really worth it. Veterans can borrow money for college same as everybody.

Now, all I got was VEAP, maximum of $8100 of which I contributed $2700, as I enlisted well before the current “College fer’ Everybuddy” craze and it was more intended to pay for trade school or similar. But it worked out to about $325 per month for two years which came in handy paying for groceries and gas back when Mrs. Panda and I were first married and had no children and few responsibilities.

Sharonsaid,

The military doesn’t have the advantage civilian residencies have in that it cannot take advantage of foreign medical graduates. More than half of family medicine residents are FMGs. It’s not surprising that as a result those in the military will be pushed into the specialties US medical graduates are running away from.

CCsaid,

The current GI Bill is a good deal. For a $100 payment (pretax) for the first year, members serving at least 36 months of active duty can get benefits of $1100 for college, tech school, etc. up to $39,000 total. This money can also be used for professional licenses and as supplementary income during residency. Say you end up acting as a flight surgeon and getting out, then do a civilian residency, you can collect the GI Bill as supplementary income until it runs out (or residency ends.) Definitely sign up (HPSP are eligible.) I am.
So $1200 ends up being worth $40,000. Not a bad deal at all. Certainly not the screw job some are calling it. That will cover all tuition at most state universities.

HPSPersaid,

I am a current HPSP student who was required to use HPSP if I wanted to go to medical school, because I did ROTC. I agree with what you wrote, HalfMD! The statistics of med students matching in the military process just don’t meet up with the civilian world at all, and many of the residencies are unavailable to med students in the military (like dermatology in the Air Force, for example–you have to complete another residency then serve 5 years as an attending before being eligible to apply for an AF dermatology residency). I wish more people knew this. I think many of us would still make the choice to do HPSP; they just would be prepared for serving a few years as a general medical officer before they hit residency, as the price paid for a free medical education.

Also, about the current GI Bill… Many, many people do NOT have access to a “cheap” state school that will make the grade for getting them a good education to jump-start their career and head them towards medical school (I am from RI, for example, that has a serious shortage of good state schools). Of course, it’s possible to get a great career and/or med school from a junior college or random state school, but it’s a lot harder in some places. Looking at the average cost of college in the US, it’s clear that the current GI bill is not adequate to pay for college in almost all cases.

confusedsaid,

I might be confused or just ignorant, but can’t you do a civilian residency before paying back your four years? There is no need to do an Air Force residency which will obviously be more restricting in terms of location and program. Let’s be honest, there is a much higher need for General Practitioners in the Air Force than Dermatologists or Plastic Surgeons. I think that is something HPSP students should be aware of before applying for the program. And I understand you are not doing your first choice job, but for goodness sake you are debt free as a physician!
It is a four year commitment to serve as a doctor, helping the people who serve our country. STOP COMPLAINING and do the job! The grass is no greener on the other side of the fence, and you can find plenty of blogs complaining about other residency programs and how ‘unfair’ they are. Each profession has standards, it just so happens that medical standards are impossibly high, and that the competition is more intense. Add the military, and you better have one strong chin…

AF HPSPsaid,

It looks like you did exactly zero homework before you accepted the HPSP and only now are realizing that the Air Force needs will come first. It doesn’t mean that you can’t go on to do whatever you want after the payback time…assuming you don’t get your #1 or #2 choice this year, which a lot of people will do. You might end up being a better physician down the road for it and have great experiences your civilian counterparts never will.

I’ve read quite a bit of your blog and you sound as though you are going into medicine purely for profit. Now you realize that you can make more money as a civilian. Your financial comparison is genius! I especially like how you commit your entire resident salary to paying back medical school loans. I guess you plan on living in a hospital closet and eating patient leftovers or maybe with your parents…that sounds awesome!!

Your selfish views of a program (HPSP) that has put so many people through medical school is laughable. For every disgruntled person like yourself, there are many more who are exteremly happy (probably understood the details before signing up).

I love how you are an expert on everything (even those you haven’t experienced yet such as residency match and life as a resident). This is your blog and you are entitled to your opinion, but when you present it as fact and that say things like “the Air Force is out to screw you” it shows what an ignorant person you are. Strange how they get people to re-enlist and stay longer than they have to and also get civilian physicians to leave the holy grail of civilian medicine to come into the Air Force. They must spike their drinks and get them to sign up before thinking it through.

The Air Force would be better off by letting you go and making you pay back your loans to them. It would be better than subjecting Airman to being treated by a selfish, arrogant physician. I can’t imagine what you’ll be like when fully trained and board certified. You already know everything as a fourth year who has no experience what-so-ever.

Jensaid,

I have seen this, or something very similar, posted several other places. I assume this is the same disgruntled person since the wording and statistics are identical. I’m sorry but this is the risk that you take in return for having your entire medical education paid for. Although it is not perfect, I must say that in this uncertain economy I would give up quite a bit more to not have the typical $300,000 in loans at graduation. Of course the AF operates on a need basis, what do you expect them to do??? You fail to mention that if you do not match, you do a rotation as a flight surgeon and then you re-enter the match afterward. You are not doomed to a specialty that you don’t want, it’s just postponed. Also, if you are not prepared to do a military residency, then you should not be signing up for the military. Do your homework and if the AF is not for you, DO NOT JOIN. If it is for you, it’s a great deal and you get to serve your country. End of story.

Half M.D.: There are many disgruntled people in the AF; I am not the only one giving you the same stats. I can tell from your post that you’re neither a medical student, nor do you know anything about the employment of civilian physicians in this economy or any other. Items you don’t address are the validity of those stats and why the AF recruiters are lying about them.

Kennysaid,

Half MD fits you perfectley because you are probably in the bottom half of you class. I have talked with with hundreds of HPSP students and the ones who suck in school all sound the same the way ” AF screwed me”. Don’t blam the AF for you lackluster grades and perfromances in med school and that is why you are not going to match to your first choice. Not mention you don’t have to do a AF residency you can always defer and go the civilian route however your results would probably be the same. I completely agree with AF HPSP you shouldn’t be in the military and if you are then I would hope you never serve where I am stationed. It is a honor to be an officer in the Unites States Air Force and based on your comments you have none of the core values that we live our lives by.

Kennysaid,

I apologize for any comments made from my email my roomy thought it would be funny. I am sorry please remove the comments from the page if you can. Sorry for the headache I hope you all have a great day.

Rebsaid,

Actually, if you do not match into a residency in the air force you are placed in a one year internship, and you are given another opportunity to match the year after that. Only if you fail to match both times do you become a flight surgeon. The AF is very generous with its options given that they have just paid for medical school. Also, there are a number of HPSP scholars who want a civilian residency (I really don’t understand why), so some of the 25% who don’t match, are just fine with that. They are also making some Army residences available to AF scholars. I believe the AF is doing more than what is needed to make acceptable options available to its future physicians.

Half M.D.: Your post makes it seem as if anyone who doesn’t match in the Air Force can go the civilian route for residency—a fallacy that recruiters continue to push. In reality, there are a limited number of slots for every specialty, even for deferrals. You must get approval to do a civilian residency. As for the 25% that don’t match—they don’t match. Period. No, they don’t get to go the civilian route. And no, they aren’t fine with their lot of doing a one-year internship in an unrelated field. Some people aren’t even given an internship. They have to find it on their own through the civilian scramble.

Also, I want you to name one Army program that accepts Air Force residents. As far as I know there aren’t any.

Finally, a consistent theme I have been trying to show on this website is that the Air Force lies about a lot of the aspects of the program. Don’t tell me that the AF is generous when I was lied to about match rates and being forced into flight surgery.

MD'shusbandsaid,

Only fitting that I post on the day the military releases their match lists. There are a lot of very happy, and few sad HPSPers out there right now. Before you start discounting anyone who disagrees with you as ignorant and ill-informed, I am the spouse of a Army Internal Med intern. We went through an exhaustive research of AF, Army and Navy HPSP programs 5 years ago before signing on the dotted line. If you failed to do the same, then you have no one to blame for your lack of due dilligence. That being said, you are correct that the recruiter’s information was misleading or incomplete. We were lucky enough to temporarily work with an Army recruiter who had been through the process herself before eventually dropping out of her residency.
As many others have already said, needs of the service always trump your whims or desires. You signed up for the military for goodness sakes. I know, you signed up for the Air Farce, so it’s eary to forget you are actually really in the military. As a former Navy officer myself (got out before meeting my wife) who “got screwed” by “needs of the service”, I’m not bitter at all, I knew what I was signing up for and the possible outcomes at the time. Though the military does treat docs with an enourmous defference (don’t ever tell a real soldier how ‘hard” your OBC was), you are still subject to the needs of the service.
As for factual errors…

You state there are no residency slots for derm or a variety of other specialties in the AF. In fact, with the merger of Brooke AMC and Wilford Hall in San Antonio, AF candidates will be able to compete for derm slots there. Likewise, with the pending merger of Bethesda and Walter Reed into a joint service hospital, you will be able to compete for such slots there in the near future.
Second, as someone else who’s actually further along in the process stated earlier, if you don’t match on your first attempt, you do a general transitional year before reapplying. Only then do you get sent out as a GMO (or flt surg in the AF).
Since the AF is the smallest service, you don’t have the selection slots availabe as the Army, so yes, you are more limited, but that comes with the territory.

For anybody else reading along researching the possibilities of going HPSP, dig, dig, dig! This is one opinion. Any recruiter will give you a sugar-coated version which is equally biased and incomplete. Do you own due dilligence, and by all means, track down a real live doc who’s actually been through the process. I’m amazed at the “buyer’s remorse” I read from HPSP med students, and the overwhelming positive feedback I’ve heard from the docs (interns, upper residents and attendings) looking back.

Another Husbandsaid,

Taking part in the HPSP may work for some and not for others. I do know from going through the entire process with my wife that the recruiter could be telling the truth, but that is a moot point if the military decides to write a policy letter. Like in the case of my wife, the Air Force decided to put policy in place that required anyone who got into a non-categorical internship to serve two years afterward as a flight surgeon before they could apply for residency. This stint as a flight surgeon would be mandatory for someone who wants to do derm and a couple of other areas, since you are not allowed to apply to derm right out of medical school, in the Air Force. This change in policy occurred after my wife signed up for HPSP.

It is amazing to me that non-residency trained doctors are allowed to practice on patients. This may be allowed in the civilian world, but at least civilians have the option not to see such a doctor. American men and women join the military in many instances to get free QUALITY healthcare. I would say that those individuals are being robbed of that promise by the military. Not to mention that flight surgeons see the cream of the crop of the military, especially in the Air Force. Pilots who are in control of multi-million dollar aircraft and technology.

I will state that I happen to be disgruntled and the selection process without a doubt puts the “needs” of the overall Air Force over the needs of the individual specialty programs by selecting people based mostly on the deployment history of the candidate. Some one year deployments in the Air Force allow the individual to get the next assignment of their choice. My wife is a highly qualified candidate and after being looked over by her desired specialty she will finish serving her four year commitment and seek a civilian residency.

Rich Gsaid,

When you sign a contract with the Air Force, you are agreeing to play by their rules. AFSC’s are filled based on the needs of the Air Force, not based on what you want. If you want complete control of your future, stay in the civilian sector. Service before self.